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DIALECTICAL BEHAVIOR THERAPY IN A NUTSHELL

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Dialectical Behavior Therapy (DBT) is a fairly new type of psychotherapy or “talk therapy.” Developed by Marsha Linehan, Ph.D., DBT was first introduced over a dozen years ago as a treatment for Borderline Personality Disorder (BPD). People with BPD (for more info on BPD click here). experience intense emotions which lead to actions such as self-injury, anger outbursts or abrupt ending of important relationships. Although these actions temporarily reduce emotional pain they often wind up causing independent problems that can make life even more difficult. Historically, BPD has been thought of as one of the most difficult problems to address effectively.  Several research studies, often referred to as clinical trials, have demonstrated that DBT is an effective treatment for adults with BPD. Both the American Psychological Association and the American Psychiatric Association currently consider DBT to be a first-line treatment for BPD (click on either Association for a link to their respective website).

As a result of DBT’s success in treating adults with BPD, it has been adapted for adolescents struggling with severe emotional turmoil and intensely problematic ways of dealing with their distress. DBT has also been modified so that it can be used with other difficulties such as eating disorders, substance use, and anger management.

So what exactly is DBT? In a nutshell, DBT is a compassionate type of behavioral therapy that is intended to help people move toward having a life that feels even more meaningful and worth living. Distress, emotional pain, interpersonal difficulties, and behavioral problems such as over-eating, not eating, using substances, self-injuring, losing control, withdrawing, and using-up relationships can make it incredibly difficult to function normally and lead a life that feels meaningful and worthwhile. DBT targets the issues that cause distress and teaches skills to deal with them without having to resort to self-defeating behaviors. It does so in a framework, though, that helps us understand that we are doing the best we can even though we need to learn ways that work better.

Now that we have a quick idea about what DBT is at its heart, how does it work? For DBT to be successful, the treatment has to do two things effectively: (1) Teach skills that people need in order to move closer toward their life goals and; (2) Help people cultivate an ability to work these skills into their daily lives.  The teaching skills part happens through our 16-week DBT Skills Group. When people sign-up for the DBT Skills Group we ask that they make a commitment to the entire 16-week course.  The Skills Group is run very much like a class or a seminar. It meets one time per week for 90-minutes.  Participants are provided with notebooks that go along with the skills being taught in group.  Homework that corresponds with the skills topics is routinely assigned and reviewed.

Individual DBT psychotherapy and DBT group therapy are two ways of developing and sharpening the ability to apply skills taught in skills group to real life. DBT clients usually meet individually with their therapist one to two times per week for 45-minute sessions.  DBT group therapy consists of 5-8 group members once a week for 90 minutes. While individual DBT therapy is more personalized, DBT group therapy offers the participant more social support as well the opportunity to see how others incorporate DBT skills into their lives. Some people choose to do both, while others enroll in one or the other. A beginning discussion of how to decide how much and what to sign-up for occurs just below. As is the case with the Skills Group, when people enroll in either individual DBT psychotherapy or DBT group therapy we ask that they make a 16-week commitment.

At our Center, we offer DBT Skills Groups, DBT group therapy, and DBT individual psychotherapy. The skills and therapy groups are held at a wide range of times during the week, including early evenings and mornings. Each group occurs for 90-minutes and participants typically attend 1-2 groups per week. DBT individual psychotherapy can be scheduled at a wide range of times, including evenings and Saturday’s.

Decisions regarding which parts of DBT to enroll in usually depend upon individual goals and whether an individual already has an individual therapist they wish to continue with and who understands and supports the goals of Skills Group training. Our Center’s therapists are available to assist in making these choices. With this said, enrolling in a Skills Group is an essential part of DBT for anyone who has not already successfully completed Skills Group training in another setting. To get to this level, we have found that the majority of people need to complete the equivalent of two cycles of our Center’s 16-week skills group.

Either DBT group therapy or DBT individual psychotherapy is also typically included in most people’s initial plans. These two parts of DBT are the main ways we have of helping people develop and sharpen their ability to apply what is learned in the Skills Group to their lives. To get an even more intensive experience, some people choose to sign-up for both.

 Several people come to our Center already involved in psychotherapy with a therapist in the community.  In these instances, we usually recommend that people enroll in both a skills and therapy group.  At other times, people may come to our Center already involved in individual DBT psychotherapy with a therapist in the community. In these cases, many people choose to limit their enrollment to a skills group. Also, whether part of our Center or not, a pre-requisite of our DBT program is that clients have an individual therapist, who may or may not be the prescribing physician.

Medication is a useful adjunct to many clients in DBT. In these cases clients need to have a prescribing physician familiar with DBT. We do not provide medication at the Center. If medication alone has successfully treated the problematic symptoms, though, there is no need for DBT. If not, it is important to understand that in undertaking DBT, DBT becomes the primary treatment. If medication side-effects interfere with effective participation in DBT, it is usually a good idea to postpone enrolling in DBT or to discuss with the prescribing physicians the pros and cons of continuing the medications at their current dose.